ranzcrpart1fandomcom-20200214-history
Radial
Arterial supply to the hand can be divided into palmar and dorsal components. Palmar arterial supply: palmar arterial supply can be divided into superficial and deep components. Superficial component * Superficial palmar arch ** superficial branch of the ulnar artery ** distal to flexor retinaculum ** superficial to the deep surface of the palmar aponeurosis ** in two-thirds of cases, the palmar arch is incomplete, and forms a hockey-stick shape ** arch lies across the centre of the palm * Common palmar digital arteries ** there are three palmar digital arteries ** branches off the superficial palmar arch ** run in the webs between fingers, splitting into two proper palmar digital arteries that supply adjacent fingers * Palmar digital artery (little finger) ** branch off the superficial palmar arch ** runs on the ulnar side of the little finger * Proper palmar digital arteries ** branches off the common palmar digital arteries ** runs on either side of each finger * Superficial palmar branch ** branch off the the radial artery ** superficial to (or travels through) the thenar muscles ** in one-third of cases, the superficial palmar branch joins the superficial palmar arch to form a true arcade Deep component * Princeps pollicis artery ** branch off the radial artery ** travels along the first metacarpal ** divides into two palmar digital branches at the metacarpal head * Radial indices artery ** branch off the radial artery ** supplies radial aspect of the index finger * Deep palmar arch ** continuation of the radial artery that anastomoses with the deep branch of the ulnar artery; often the arch is complete (unlike the superficial arch) ** originates between the oblique and transverse heads of adductor pollicis ** lies 1cm proximal to the superficial arch * Palmar metacarpal arteries ** there are three palmar metacarpal arteries ** branches off the deep palmar arch ** at the metacarpal heads, they anastamose with the common palmar digital branches of the superficial arch ** they perforate the interosseous spaces to anastomose with the dorsal metacarpal arteries Dorsal arterial supply * Posterior carpal arch ** anastomosis between the radial, ulnar, and anterior interosseous arteries ** lies dorsal to the wrist * Dorsal metacarpal arteries ** branches off the posterior carpal arch ** split at the webs to supply dorsal sides of the fingers ** they anastomose with the deep palmar arch via the palmar metacarpal arteries Vascular variations: * Dorsal arches ** Radiocarpal arch: Present in 80%, most important for carpal vascular supply; anastomoses variable: Radial & anterior interosseous (occurs 80%); radial, ulnar & interosseous (occurs less commonly) ** Dorsal carpal (intercarpal) arch: Present in 99%; anastomoses variable: Radial, ulnar, & interosseous (occurs 53%); radial & ulnar (20%); radial & interosseous (20%); ulnar & interosseous (7%) ** Basal metacarpal arch: Complete in 27%, absent in 27%; partial (radial only) in 46% * Volar arches ** Radiocarpal arch: Present in 100%; anastomoses: Ulnar, radial & interosseous anastomoses (87%); radial & ulnar (13%) ** Intercarpal arch: Smallest & most variable; seen in only 53%; anastomoses: Radial, ulnar & interosseous (75%); radial & ulnar (25%) ** Deep palmar arch: Present in 100%; anastomoses: Radial & ulnar (97%); no anastomoses between radial & ulnar (13%): Proximal, deep & distal systems arise from this arch; volar arches are connected longitudinally by radial, ulnar & interosseous arteries & deep palmar recurrent arteries (which arise from deep palmar arch)